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OCT
16
0

Importance of Addressing Third-Party Audits Properly

Third-party audits have the potential to wreak havoc on independent pharmacies.An audit on its own can be extremely costly due to time dedicated to gathering necessary documents and assisting the auditor.  Further, any discrepancies found can be subject to adjustments of thousands of dollars. Suspected misconduct has recently led to refer...
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  1298 Hits
1298 Hits
OCT
16
0

Medicare Appeals Backlog – Light at the End of the Tunnel?

The number of Medicare appeals cases pending to be heard by administrative law judges has been growing exponentially.  The backlog is now almost ten times larger than it was five years ago and is projected to reach two million by 2020 if no change is made.  The appeals process, as of now, takes at least three to four years, duri...
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  1147 Hits
1147 Hits
OCT
16
0

Merger Mania: Exploring the Impact of ESI/Cigna and CVS/Aetna Mergers on Independent Pharmacies

In a ground-shaking two weeks, the Antitrust Division of the U.S. Department of Justice approved multiple PBM/insurer mergers: first, the merger of Express Scripts Inc. and Cigna, and now, the merger of CVS Health (formerly CVS Caremark) and Aetna.  Both mergers marked major milestones. ESI was the last standalone major PBM, while the CVS...
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  1440 Hits
1440 Hits
SEP
23
0

DOJ APPROVES CIGNA-EXPRESS SCRIPTS MERGER

This is the time for independent pharmacies to be actively preparing for the impact of the Cigna-ESI merger—and the ensuing Aetna-Caremark merger—if they have not already done so. The Antitrust Division of the U.S. Department of Justice has approved the proposed Cigna-Express Scripts merger, clearing a significant obstacle to Cigna's acquisition of...
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  1227 Hits
1227 Hits
SEP
04
0

HHS Echoes Importance of HIPAA Compliance for Closed Businesses

Recently, HHS reiterated that severe consequences can be imposed for HIPAA violations, regardless of whether a business is still operational. If HIPAA violations were committed, a business can be charged long after its doors close. Moreover, providers working with associates who shut down operations or went bankrupt are equally liable for HIPAA vio...
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  1565 Hits
1565 Hits
SEP
04
0

CMS Updates Final Adverse Actions to Be Reported

CMS has released a list of updated final adverse actions that need to be reported to CMS in a timely fashion. The list includes, but is not limited to, certain convictions, exclusions, and revocations, regardless of whether records are expunged.  Additionally, CMS revoked certain requirements of Medicare enrollment in an effort to reduce provi...
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  1268 Hits
1268 Hits
AUG
18
0

Physical Therapy Practices are Growing – But Also Face Increased Challenges

2006 was a monumental year for New York physical therapists – New York State passed a law permitting physical therapists to directly treat patients without a referral from a physician, triggering an explosion of private physical therapy practices. Over a decade later, private practice is still thriving in the industry.  As patient volume ...
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  1559 Hits
1559 Hits
AUG
16
0

Compounding Pharmacies Under Scrutiny for Medicare Part D Billing Practices

OIG calls for "further scrutiny" of pharmacies and prescribers in connection with compounded drugs billed to Medicare Part D.   Pharmacies must be prepared to aggressively defend against this latest attack on the independent retail pharmacy industry. An explosive new report calls for "further scrutiny" of hundreds of pharmacies and prescr...
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  1494 Hits
1494 Hits
JUL
19
0

Can a Physician’s Medical Judgment be Basis for a False Claims Action? Appellate Court Rules Yes.

A doctor's certification or medical judgment regarding a certain treatment can be considered "false" if the treatment is not considered "reasonable and necessary" under the government's definition, even if the terms are not defined for the specific medical treatment. In a recent decision, United States ex rel. Polukoff v. St. Mark's Hospital ,...
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  1656 Hits
1656 Hits
JUL
02
0

Nationwide Crackdown Charges 601 Individuals with Over $2 Billion in Healthcare Fraud

In a sweeping crackdown that vastly exceeded investigations of years' past, the U.S. Department of Justice and Medicare Fraud Strike Force charged 601 individuals with over $2 billion in healthcare fraud. In Brooklyn and Long Island alone, numerous healthcare providers were charged with over a combined $163 million in healthcare fraud. The Medicare...
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  1576 Hits
1576 Hits
JUN
25
0

New Jersey Act Imposes New Requirements to Protect Consumers

New Jersey providers should be alert to the recently signed into law Out-of-Network Consumer Protection, Transparency, Cost Containment, and Accountability Act.The Act pertains to, and enhances, consumer protections related to out-of-network healthcare charges.Health care facilities and professionals must ensure their compliance with these new requ...
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  1329 Hits
1329 Hits
JUN
08
0

New York State Takes Action Against Abusive PBM Audits, Grants New Protections to Independent Pharmacies

The recently passed New York State budget bill including sweeping new protections for independent pharmacies facing PBM audits.  The bill, which amends the Public Health Law, requires PBMs, when conducting audits, to accept purchase invoices from a broader range of wholesalers and distributors.  This provision is notable as PBMs...
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  1892 Hits
1892 Hits
JUN
04
0

What NYC Employers Must Know About the Safe Leave Law

The former NYC Earned Sick Time Act, popularly known as the Paid Leave Law, is now the Earned Safe and Sick Time Act.  Previously, the Act obligated employers to provide a certain amount of sick leave for their employees. The new amendments to the Act, which are presently going into effect, allow employees to use paid leave not only for s...
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  1470 Hits
1470 Hits
JUN
04
0

New York State Imposes Limitations on LHCSA Applications

Recently, New York State implemented a two-year moratorium on the processing and approval of applications for licensure of Licensed Home Care Service Agencies ("LHCSAs").This moratorium suspends the Department of Health's processing of LHCSA applications, subject to certain exceptions. Presently, the exceptions include applications for ALP-Related ...
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  1160 Hits
1160 Hits
NOV
29
0

The Rising Cost of Employing Excluded Individuals

Healthcare providers are increasingly feeling the cost of employing excluded individuals.Indeed, over the past year, the number of enforcement actions taken against physician's offices, pharmacies and other entities employing excluded individuals have risen sharply. "Excluded individuals" are parties excluded from Federally-funded healthcare progra...
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  2259 Hits
2259 Hits
NOV
15
0

Under the Travel Act, Aggressive Federal Enforcement Against Providers Expands

Q.  When does a purely state criminal law-based matter transform into a federal felony prosecution? A.  When the Federal Travel Act (the "Travel Act") is implicated.Under the Act, a party who travels in interstate commerce or uses the mail or any facility in interstate commerce, with intent to promote or carry on "unlawful activities...
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  2111 Hits
2111 Hits
OCT
11
0

FEDERAL CRACKDOWN ON PRESCRIBERS OF COMPOUNDED MEDICATIONS

A recent health care fraud guilty plea by a physician has caught the attention of prescribing physicians and the broader industry surrounding compounded medications.Under the plea agreement in New Jersey District Court, the physician admitted to prescribing approximately $25 million worth of compounded medications that were either medically unneces...
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  2264 Hits
2264 Hits
SEP
26
0

COMPOUNDING PHARMACIES MAY SOON HAVE NEW MARKET OPPORTUNITIES

Compounding pharmacies, one of the fastest growing sectors in retail pharmacy, may soon be able to expand the market for their products in exchange for agreeing to be placed directly under federal oversight, according to U.S. Food & Drug Administration Commissioner Scott Gottlieb. Currently, a sterile compounding pharmacy may&nbs...
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  2109 Hits
2109 Hits
SEP
21
0

PHARMACY COMPLIANCE UPDATE: GROWING YOUR MEMBERSHIP PROGRAM

Membership programs are a common tool used by retail pharmacies to grow their business. Under this type of program, a pharmacy will give member patients certain benefits, usually taking the form of rebates, discounts, or coupons on in-store items, as a way of developing customer loyalty. As these member patients often fill prescriptions at the same...
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  1878 Hits
1878 Hits
JUL
14
0

Medicare Fraud Strike Force Announces $1.3 Billion Healthcare Fraud Takedown

In what is becoming an annual tradition, the Medicare Fraud Strike Force, comprised of members from the U.S. Department of Justice and the Department of Health and Human Services (more about which can be read here ), announced the latest "unprecedented" healthcare fraud takedown. The nationwide bust netted more than 412 individuals suspected of a c...
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  2250 Hits
2250 Hits